IUD usage is on the rise in U.S.

After two decades of being about as popular as chastity belts, the intrauterine device is catching on again in this country.

IUD use nearly tripled in just six years, growing from 2 percent of birth-control users in 2002 to about 6 percent in 2008, according to the latest federal survey. That translates to 2.1 million women - and the kind of market growth not seen since sales peaked in the 1970s.

Medical organizations and health activists are finally succeeding in debunking the idea that all IUDs are dangerous, a misconception rooted in the Dalkon Shield debacle of the 1970s. Clinicians are once again touting the method's hassle-free, long-acting, reversible benefits, while websites like IUD Divas let women share every cramp, question, and concern.

This is not to suggest the IUD is now free of controversy. Regulators have been cracking down on physicians who turn to Canada for cut-rate ParaGard and Mirena IUDs - the only two brands approved in the United States - as a way to save money.

Cost is the one obstacle to IUD use that has grown, not lessened. Bayer Healthcare Pharmaceuticals, which acquired market dominator Mirena in 2006, announced four months ago that it was raising the retail price to $843, an 80 percent increase.

"It's blatant corporate greed," said Jennifer Boulanger, executive director of the Allentown Women's Center, whose outraged letter to her Bayer sales rep was ignored.

Bayer spokeswoman Rose Talorico countered that even with the increase, Mirena is a bargain, given that it lasts for five years: "Mirena is significantly less than today's average monthly cost for hormonal contraceptives."

The doctor factor

Many factors were behind the IUD's heyday in the 1970s, including the advent of flexible plastic, the sexual revolution, lax regulation of medical devices, and fear of the Pill's hormone-related bad effects.

But the force that stands out in the rise - and fall and rise - of the IUD is physicians.

Obstetrician-gynecologists invented many IUDs, including the Dalkon Shield, and initially sang the praises of the method, which interferes with the sperm and egg in ways that remain mysterious. At the high point, almost 10 percent, or 2.5 million, of U.S. women had IUDs.

Doctors also did much of the research that gave the IUD a bad rep and killed demand.